Delays, wait times plague new Tricare contractor

May. 2, 2013 - 04:21PM
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April was a bad month for an Army captain’s family at Fort Carson, Colo. Their 16-year-old daughter, already enrolled in weekly therapy for substance abuse, was becoming increasingly unruly, ditching classes, disappearing for hours and relapsing into drinking and smoking pot.

Counselors recommended a 21-day inpatient dependency program, one she had attended previously with some success.

The active-duty family had no reason to believe the treatment would be denied.

But in mid-April, UnitedHealthcare Military & Veterans — the contractor that assumed management of the Tricare West region on April 1 — rejected the referral.

“United wouldn’t admit her for this treatment. We were told they didn’t think she needed it. I didn’t know United staff were doctors,” said the girl’s father, an active-duty officer with six years of military service who asked that his name not be used.

UnitedHealthcare is the first new company to take over a Tricare contract since the military health program’s regions were consolidated in 2004.

No one expected the transfer of health care management for 2.9 million beneficiaries in 21 states to be flawless. But a month into the contract, the Tricare Management Activity has received 1,347 customer service calls concerning UnitedHealthcare’s responsiveness, or lack thereof. Most concern prolonged wait times for the company’s customer service representatives, but 228 involved referral and authorization complaints.

Other beneficiaries have protested on Tricare’s Facebook page.

“I was appalled to be placed on hold for 40 minutes. However, to put my doctor’s office on hold for an hour and 45 minutes is neglectful,” wrote Dawn C. Francis.

“My cancer isn’t waiting for authorization! I don’t understand why United is taking so long to approve a basic request for a standard procedure that I have annually,” added Michelle Oakland.

Beneficiaries and physicians have begun contacting Congress for help.

“The problem is widespread and includes critical health specialties where a month-long delay in receiving care could have a significant negative health impact,” explained Rep. Doug Lamborn, R-Colo., who sent a letter April 26 to United Healthcare chief executive Gail Boudreaux. “The current situation is unacceptable.”

UnitedHealthcare Military & Veterans was awarded the Tricare West Region contract, worth up to $21 billion over the next five years, in July 2012 after a prolonged contract award and protest process that began in 2009.

That year, the company was given the contract to manage the Tricare South region but the decision later was overturned, opening up a chance for United Healthcare, UnitedHealthcare Military & Veterans’ parent company, the nation’s largest private health insurer, to bid for the West region contract against TriWest Healthcare Alliance.

TriWest officially passed the baton on April 1.

Both Tricare and UnitedHealth acknowledge there have been growing pains. Among the major concerns: long delays in reaching customer service and issues with providers not receiving timely referrals.

“Through on-site visits to the contractor’s facilities and daily meetings with the contractor, Tricare Management Activity leadership is closely monitoring UnitedHealthcare’s effort to improve customer service to providers and beneficiaries in the West Region,” TMA spokesman Austin Camacho said.

“We are very apologetic that people have had to wait as long as they have on the phone and had difficulties accessing the web portal. We understand the problems and are taking aggressive action to fix them,” said Bruce Jasurda, UnitedHealthcare Military & Veterans vice president of communications.

This includes authorizing “significant overtime and working 24/7,” Jasurda added.

In the first month of service, UnitedHealthcare’s communications center logged 531,000 calls, with an average wait time of about five minutes, according to company officials.

Lamborn said physicians and providers in specialty fields have told him they may need to cut staff because patients aren’t receiving timely referrals.

“These medical providers are facing unexpected and dramatic reductions in their workload and are now faced with the prospect of laying off employees,” he said.

Sen. Mark Udall, D-Colo., said his office also is receiving calls from from military treatment facilities, health providers and military families.

“We must ensure that patients get timely qualified care that isn’t bogged down by red tape during this transition,” said Udall, a member of the Senate Armed Services Committee. “My office will work with providers, UnitedHealthcare, the military and patients to ensure that the issues that have surfaced during the transition are resolved.”

Lamborn sent a letter Thursday to Defense Secretary Chuck Hagel asking for “immediate action to ensure the proper medical care for military families.”

“I do not want this to go on much longer,” Lamborn said during a telephone interview with Military Times. “It has gone on too long already.”

Any fix to the quagmire has come too late for the Army captain’s daughter, though. After numerous phone calls to UnitedHealth, her father secured approval for treatment, but UnitedHealth agreed to pay only for up to seven days.

She attended and at the end of the week was released back to her family, which has since moved her to live with relatives in another state and Tricare region.

“To this day, we haven’t received an explanation from UnitedHealth as to why her care was denied. We’re hoping the change in her environment will help level things out long enough so we can start looking at other treatment options,” said her father.